Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low Extended-spectrum beta-lactamase (ESBL) prevalence cohort

Figures & data

Figure 1 Flow diagram presenting the inclusion and exclusion procedure for patients with Escherichia coli (E. coli) bacteremia.

Table 1 Characteristics of Eshericha coli bacteremia cases regarding antimicrobial therapy from 2010 to 2012

	All patients (%)	Cefuroxime (%)	Piperacillin/tazobactam (%)	OR (95% CI)	P-value
	n=568	n=377	n=191
Age [median (25–75 percentiles)]	76 (62–84)	75 (61–84)	77 (62–84)		0.38
Gender (female)	318 (56.0)	220 (58.4)	98 (51.3)	1.33 (0.94–1.89)	0.13
Acquisition (n=503)
Community-acquired	331 (61.8)	211 (62.8)	100 (59.9)	1.00
Health care related	110 (21.9)	70 (20.8)	40 (24.0)	0.83 (0.53–1.31)	0.42
Hospital-acquired	82 (16.3)	55 (16.4)	27 (16.2)	1.04 (0.62–1.74)	0.89
Charlson Comorbidity Index
Low	157 (27.6)	105 (27.9)	52 (27.2)	1.00
Medium	207 (36.4)	143 (37.9)	64 (33.5)	1.11 (0.71–1.72)	0.66
High	204 (35.9)	129 (34.2)	75 (39.3)	0.85 (0.55–1.32)	0.47
Intensive care unit	6 (1.1)	3 (0.8)	3 (1.6)	0.50 (0.10–2.51)	0.41
Intervention hospital	175 (30.8)	7 (1.9)	168 (88.0)	0.003 (0.001–0.006)	<0.01
Polymicrobial bacteraemia (n=503)	16 (3.2)	9 (2.3)	7 (4.2)	0.65 (0.24–1.78)	0.43
Resistant strain	38 (6.7)	21 (5.6)	17 (8.9)	0.60 (0.31–1.17)	0.16
Combination therapy with gentamicin	83 (14.6)	64 (17.0)	19 (9.9)	1.85 (1.07–3.19)	0.03
Combination therapy with ciprofloxacin	175 (30.8)	94 (24.9)	81 (42.4)	0.45 (0.31–0.65)	<0.01
14 days mortality	60 (10.6)	45 (11.9)	15 (7.9)	1.5 (0.86–2.93)	0.09
30 days mortality	88 (15.5)	61 (16.2)	27 (14.1)	1.17 (0.72–1.92)	0.31

Note: P<0.05 shown in bold.

Table 2 Characteristics of E. coli bacteremia cases regarding hospitals from 2010 to 2012

	Intervention hospital (%)	Other hospitals (%)	OR (95% CI)	P-value
	n=175	n=393
Age [median (25–75 percentiles)]	77 (64–84)	75 (61–84)		0.24
Gender (female)	92 (52.6)	226 (57.5)	0.82 (0.57–1.17)	0.31
Acquisition (n=553)
Community-acquired	96 (63.2)	215 (61.3)	1.00
Health care related	34 (22.4)	76 (21.7)	1.00 (0.63–1.61)	0.99
Hospital-acquired	22 (14.5)	60 (17.1)	0.82 (0.48–1.42)	0.48
Charlson Comorbidity Index
Low	45 (25.7)	112 (28.5)	1.00
Medium	61 (34.9)	146 (37.2)	0.96 (0.61–1.52)	0.87
High	69 (39.4)	135 (34.4)	1.27 (0.81–2.00)	0.30
Intensive care unit	1 (0.6)	5 (1.3)	0.45 (0.05–3.85)	0.67
Polymicrobial bacteraemia (n=503)	8 (5.3)	8 (2.0)	2.25 (0.83–6.08)	0.17
Resistant strain	15 (8.6)	23 (5.9)	1.51 (0.77–2.97)	0.28
Combination with gentamicin	19 (10.9)	64 (16.3)	0.63 (0.36–1.08)	0.10
Combination with ciprofloxacin	68 (38.9)	107 (27.2)	1.70 (1.17–2.48)	<0.01
Treatment with cefuroxime	7 (4.0)	370 (94.1)	0.003 (0.001–0.006)	<0.01
14 days mortality	14 (8.0)	46 (11.7)	0.66 (0.35–1.23)	0.24
30 days mortality	24 (13.7)	64 (16.3)	0.82 (0.49–1.36)	0.46

Note: P<0.05 shown in bold.

Table 3 Analysis of 14-day mortality with unadjusted and adjusted cox proportional hazards regression model

	Deaths (%)	Survivors (%)	Unadjusted		Adjusted
	n=60	n=508	Mortality rate ratio (95% CI)	P-value	Mortality rate ratio (95% CI)	P-value(P<0.05 in bold)
Age [median (25–75 percentiles)]	74 (66–84)	71 (61–84)	1.01 (0.99–1.03)	0.26
Gender (female)	29 (48.3)	289 (56.9)	0.71 (0.41–1.21)	0.22
Acquisition (n=503)
Community-acquired	21 (39.6)	290 (64.4)	1.00		1.00
Health care related	20 (37.7)	90 (20.0)	3.07 (1.59–5.92)	<0.01	3.39 (1.77–6.49)	<0.01
Hospital-acquired	12 (22.6)	70 (15.6)	2.37 (1.11–5.04)	0.03	2.17 (1.02–4.62)	<0.05
Charlson Comorbidity Index
Low	11 (18.3)	146 (28.7)	1.00		1.00
Medium	21 (35.0)	186 (36.6)	1.50 (0.70–3.21)	0.30	1.47 (0.65–3.32)	0.35
High	28 (46.7)	176 (34.6)	2.11 (1.02–4.39)	<0.05	1.93 (1.05–3.53)	0.06
Intensive care unit	3 (5.0)	3 (0.6)	8.87 (1.75–44.93)	0.02	20.45 (5.31–78.82)	<0.01
Intervention hospital	14 (23.3)	161 (31.7)	0.66 (0.35–1.23)	0.24	0.60 (0.32–1.59)	0.15
Polymicrobial bacteraemia (n=503)	2 (3.3)	14 (2.8)	1.05 (0.24–4.72)	1.00	1.75 (0.50–6.05)	0.35
Resistant strain	17 (28.3)	94 (18.5)	1.31 (0.49–3.49)	0.58
Combination with gentamicin	8 (13.3)	75 (14.8)	0.88 (0.41–1.95)	1.00
Combination with ciprofloxacin	25 (41.7)	150 (29.5)	1.71 (0.99–2.95)	0.08	2.14 (0.98–4.68)	0.04
Treatment with cefuroxime	45 (75.0)	332 (65.4)	1.59 (0.86–2.93)	0.15	3.95 (1.12–13.90)	0.02

Note: P<0.05 shown in bold.

Figure 2 Cox regression survival curves for 14-day survival after antibiotic treatment onset.